System In England Research Articles

‘The first initial bit was trying to get her to speak to me’: trauma informed relationship-based practice with female offenders in care

ABSTRACT This article reports on findings from a research project that explored how youth offending practitioners applied a trauma-informed approach to relationship-based practice when working with girls who were in both State care and contact with the Criminal Justice System in England. The study was conducted in three local authorities, using semi-structured interviews with 20 youth offending practitioners. The findings suggest effective youth offending practice with this group of young women is distinctive in prioritising complex welfare needs as a route to addressing offending. This is managed in practice through developing strong and supportive relationships that are individualised and led by young women. This bespoke approach to criminal justice practice presents challenges to the traditional care/control dichotomy and adds to the developing discussion around ambiguities of role when addressing vulnerabilities through a criminal justice lens. It also discusses ethical issues when considering wider systemic structures around these girls and their future pathways. Finally, the article argues that an explicit intersectional trauma-informed approach reframes youth offending practice and allows practitioners to navigate the inherent tension in the care and control dichotomy, creating relationships that are containing, predictable and safe for young women in care with histories of trauma.

Contexts and complexities: a realist evaluation of integrated care system leadership.

This paper presents a realist evaluation of leadership within an integrated care system (ICS) in England. This paper aims to examine which aspects of leadership are effective, for whom, how and under what circumstances. Realist evaluation methodology was used, adopting prior realist review findings as the theoretical framework to refine explanations of how and why leadership within an ICS is effective. Between January and November 2023, 23 interviews with ICS leaders took place, alongside 7 meeting observations and documentary analysis. The Realist And Metanarrative Evidence Syntheses: Evolving Standards (RAMESES) guidance informed the study design, conduct and reporting. The findings highlight two overarching infrastructural contexts influencing leadership in ICSs: the impact of the post-COVID-19 pandemic legacy and the differences between health and social care regulatory and financial environments. Findings demonstrate that ICS leaders identified a strong sense of purpose as crucial for guiding decisions and creating a psychologically safe environment for open, honest discussions, fostering calculated risk-taking. Whilst a shared vision directed priority setting, financial pressures led to siloed thinking. Leadership visibility was linked to workforce morale, with supportive leadership boosting morale amidst evolving ICS landscapes and confidence in data-driven decisions supported prevention activities. However, financial constraints hindered responsiveness and innovation in addressing health inequalities. By examining ICS leadership post-COVID-19 pandemic and amidst varying regulatory and financial environments, this study contributes to the emerging literature on systems leadership and offers practical guidance for leaders navigating the complexities of integrated care.

Factors associated with biological and targeted synthetic disease-modifying antirheumatic drug initiation for rheumatoid arthritis in underserved patient groups in England and Wales, UK: a national cohort study

Quantifying health-care inequality is essential to addressing the imbalance in outcomes attributable to age, sex, race or ethnicity, and multimorbidity. In this study, we analysed differences in the initiation of biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis within the universal health-care system of England and Wales, UK. An observational cohort study was conducted using the National Early Inflammatory Arthritis Audit (NEIAA) dataset. We included all patients with rheumatoid arthritis who were enrolled in NEIAA between May 8, 2018, and April 30, 2022, and who had 12-month follow-up data available. Modified Poisson regression was used to explore factors associated with the initiation of biological and targeted synthetic DMARDs within 12 months of initial rheumatology assessment. The factors evaluated included age, sex, ethnicity, socioeconomic status (index of multiple deprivation), smoking status, and relevant comorbidities (lung disease, cardiovascular disease, cancer, and depression). NEIAA is supported by people with lived experience of rheumatoid arthritis, who contributed to study design and the interpretation of findings. 6098 patients in NEIAA had new diagnoses of rheumatoid arthritis and available follow-up data. The mean age was 59·2 years (SD 14·9); 3912 (64·2%) patients were women and 2186 (35·8%) were men. 6047 (99·2%) patients had available ethnicity data, of whom 5215 (86·2%) were White, 152 (2·5%) were Black, 478 (7·9%) were Asian, and 202 (3·3%) were of mixed or other ethnicities. 508 (8·3%) of 6098 patients initiated biological and targeted synthetic DMARDs within 12 months. Patients younger than 40 years were more likely to be initiated on biological and targeted synthetic DMARDs than individuals older than 65 years (multivariable-adjusted risk ratio 2·41 [95% CI 1·83-3·19]; p<0·0001). Asian individuals were less likely to be initiated on biological and targeted synthetic DMARDs than White individuals (0·52 [0·36-0·76]; p=0·0007), which persisted after adjustment for socioeconomic status, comorbidities, baseline disease severity, and the initial response to conventional synthetic DMARDs. These differences were evident for Asian women but not Asian men. Black individuals were more likely to be initiated on biological and targeted synthetic DMARDs than White individuals (1·54 [1·10-2·16]; p=0·012), which became non-significant after adjusting for baseline disease severity and autoantibody status. The initiation of biological and targeted synthetic DMARDs for patients with newly diagnosed rheumatoid arthritis varies markedly by ethnicity and age in the universal health-care system of England and Wales. This study demonstrates the importance of providing tailored information and ensuring equitable access to high-quality care for underserved patient groups. The one-size-fits-all approach must be reconsidered if health disparities are to be mitigated effectively. Sandoz UK.

Understanding Special Educational Needs and Disabilities Assessment and Review Team experiences to improve and inform special educational needs and disabilities systems in England

Understanding Special Educational Needs and Disabilities Assessment and Review Team experiences to improve and inform special educational needs and disabilities systems in England

SIX STEPS TO HELP IMPROVE ADOPTION

Around 3,500 children are adopted in the UK each year. To mark National Adoption Week, an expert explores challenges facing the adoption system in England and examples of good practice are showcased

Research on Graph Multi-Attention Neural Network for Power System Transient Stability Assessment

Abstract Diagnosing the stability of power grids based on artificial intelligence technology is a research trend. The existing artificial intelligence stability analysis methods rely on a large number of fault case data, while the graph neural network method ignores the correlation characteristics of nodes themselves and the correlation of long-distance nodes. In order to solve the problems, the graph multi-attention neural network (GMANN) was proposed. The self-attention, which characterizes the correlation between different state quantities of a single node, is proposed, firstly. Then, long-distance association attention, which represents the correlation of distant nodes in the power grid, was proposed. The long-distance correlation attention and the adjacent correlation attention in graph attention network are fused to form a global attention that reflects the global importance of the power grid. The channel attention that characterizes the importance of different pooling methods of graph convolutional network is extracted and used to obtain the importance of different convolution operations. Finally, based on the multi-source attention fusion strategy, global attention and channel attention are embedded in the graph attention neural network to form a multi-level evaluation model to achieve power grid stability evaluation efficiently guided by multiple attentions. The proposed GMANN is verified based on simulated fault cases obtained from the 10-machine 39-node system in New England. The results show that the accuracy of the GMANN can reach 97.34%, which is better than other methods. And the missed judgment rate of important indicators is significantly better than other methods.

Investigating child-facing practitioners' understanding of adversity and its impact on children's development and service provision

Adversity during childhood is a common risk factor for poorer outcomes across physical, mental, and social health. Despite growing evidence and policy around preventing adversity and its sequalae, the incidence of adversity in childhood remains high. Child-facing practitioners (CfPs) may be well-placed to identify adversity and address its impact on children. This study investigated the understanding of adversity and current practice of CfPs working in the Education system, Healthcare and Social Care in England. An anonymous online survey was completed by 113 CfPs between April and June 2022. Data were analysed using descriptive statistics. Participating CfPs' reported using a range of assessment tools and direct observation, but there was a lack of consistency in the extent to which different types of adversity were explored in assessments. CfPs working in the Education system and Healthcare reported only liaising with Social Care services when a current worker was known to be involved with the family, or to make a referral. Indeed, a quarter of respondents from the Education system and Healthcare only considered early life experiences when capacity allowed. Over half of the CfPs in this survey 'did not know' or 'did not agree' that public services offer interventions to support families experiencing domestic abuse, parental mental health difficulties and addiction, or the impact of these adversities on children's wellbeing. The study highlights that CfPs could benefit from further training about the prevalence and impact of adversity to inform service delivery. A review of CfPs' routine assessments is needed to ensure that children's exposure to adversity is routinely identified; this will facilitate families to access appropriate support to mitigate the impact of such experiences.

Increasing engagement with liver disease management across the UK: follow-up cross-sectional survey.

Liver disease is an increasing cause of premature mortality. Early detection of liver disease in primary care gives opportunity to intervene and change outcomes. Engagement in liver disease care by NHS bodies responsible for primary care pathway development could drive improvements. The formation of integrated care systems (ICS) in England provides an opportunity to reassess engagement with liver disease nationally. To update the level of engagement with community chronic liver disease management amongst ICSs and health authorities across the UK. A cross-sectional follow up survey to ICS and UK Health Boards. Questions used for a previous survey in 2020 were adapted and sent electronically to NHS bodies responsible for health care across the UK using a Freedom of Information request. Quantitative analysis used Microsoft Excel. There were 67 responses from 68 possible ICS and Health Board areas representing 99% UK coverage. 27% had a named individual responsible for liver disease. Monitoring of local liver disease health statistics happened in 34% of all UK areas. Comprehensive care pathways were available in 24/67 (36%) of areas, an increase from 26% in the 2020 survey. Areas with no liver pathways in place fell from 58% to 36% between the two surveys. Regional variations persist, with Wales and Scotland moving towards comprehensive coverage. Almost double the number of areas were making use of transient elastography within community pathways of care, up from 25% to 46%. The results of this re-survey highlight improvements, but emphasise the need to build on regional success to further reduce inequality in care commissioning.

Mercury enrichments as a paleo-volcanism proxy: Sedimentary bias and a critical analysis across the end-Triassic

Mercury (Hg) anomalies in sedimentary rocks have been increasingly used in paleoclimatology studies for tracing volcanic signals, as Hg emissions from volcanic activity can cause contemporaneous sedimentary Hg enrichment. However, non-volcanic sedimentary controls on Hg have clear potential to mask these signals. These factors include host phase variability linked to environmentally controlled sourcing and settling changes, and/or variable preservation conditions associated with weathering, oxidation and diagenesis. Such factors can limit the efficacy of Hg as a paleo-volcanism proxy. In this study, sedimentary effects on Hg concentration within a complex depositional system in southwest England (St. Audrie's Bay) across the end-Triassic have been analyzed, together with published data from coeval end-Triassic sections globally – an interval of time coeval with the Central Atlantic Magmatic Province (CAMP). Our statistical analysis of Hg and associated geochemical data highlights significant fluctuations in sedimentary Hg due to relative supply differences in Hg and host phases, as well as the changing types and preservation conditions of host phases. End-Triassic sections globally show a consistent undersupply of Hg relative to organic matter across the end-Triassic mass extinction (ETME). To better assess the magnitude and significance of possible Hg enrichments in sedimentary rocks, we present a statistical method for quantifying Hg anomalies to robustly distinguish Hg variations linked to host phase/depositional changes from paleo-volcanism. Our method supports the existence of transient but asynchronous Hg anomalies linked to volcanism from the CAMP across the end-Triassic in most global sections, albeit not in the St. Audrie's Bay section.

Association between surgeon training grade and the risk of revision following unicompartmental knee replacement: An analysis of National Joint Registry data.

Unicompartmental knee replacements (UKRs) are performed by surgeons at various stages in training with varying levels of supervision, but we do not know if this is a safe practice with comparable outcomes to consultant-performed UKR. The aim of this study was to use registry data for England and Wales to investigate the association between surgeon grade (consultant, or trainee), the senior supervision of trainees (supervised by a scrubbed consultant, or not), and the risk of revision surgery following UKR. We conducted an observational study using prospectively collected data from the National Joint Registry for England and Wales (NJR). We included adult patients who underwent primary UKR for osteoarthritis (n = 106,206), recorded in the NJR between 2003 and 2019. Exposures were the grade of the operating surgeon (consultant, or trainee) and whether or not trainees were directly supervised by a consultant during the procedure (referred to as "supervised by a scrubbed consultant"). The primary outcome was all-cause revision surgery. The secondary outcome was the number of procedures revised for the following specific indications: aseptic loosening/lysis, infection, progression of osteoarthritis, unexplained pain, and instability. Flexible parametric survival models were adjusted for patient, operation, and healthcare setting factors. We included 106,206 UKRs in 91,626 patients, of which 4,382 (4.1%) procedures were performed by a trainee. The unadjusted cumulative probability of failure at 15 years was 17.13% (95% CI [16.44, 17.85]) for consultants, 16.42% (95% CI [14.09, 19.08]) for trainees overall, 15.98% (95% CI [13.36, 19.07]) for trainees supervised by a scrubbed consultant, and 17.32% (95% CI [13.24, 22.50]) for trainees not supervised by a scrubbed consultant. There was no association between surgeon grade and all-cause revision in either crude or adjusted models (adjusted HR = 1.01, 95% CI [0.90, 1.13]; p = 0.88). Trainees achieved comparable all-cause survival to consultants, regardless of the level of scrubbed consultant supervision (supervised: adjusted HR = 0.99, 95% CI [0.87, 1.14]; p = 0.94; unsupervised: adjusted HR = 1.03, 95% CI [0.87, 1.22]; p = 0.74). Limitations of this study relate to its observational design and include: the potential for nonrandom allocation of cases by consultants to trainees; residual confounding; and the use of the binary variable "surgeon grade," which does not capture variations in the level of experience between trainees. This nationwide study of UKRs with over 16 years' follow up demonstrates that trainees within the current training system in England and Wales achieve comparable all-cause implant survival to consultants. These findings support the current methods by which surgeons in England and Wales are trained to perform UKR.

Measuring error in the Demographic Index – steps towards a future population statistics system in England and Wales

ObjectiveWe are developing methods to measure the quality of the Demographic Index at a National Statistics Institute. The Demographic Index is the foundational dataset for a future, transformed, population statistics system for England and Wales. It clusters records for individuals across many years of health, education, and tax data, and assigns them a unique ID. Previous research has helped us to conceptualise three types of error in the Demographic Index: clustering error, coverage error, and data measurement error. We are currently working on estimating one type of clustering error, whereby records for two individuals are mistakenly assigned the same ID (“false positive clusters”). ApproachPrevious work has allowed us to identify variables associated with false positive clusters. We are now working on a stratification method, whereby each ID in the Demographic Index is scored according to how likely it is to contain this error. We plan to measure uncertainty using bootstrapping. Results and ConclusionsThis work is ongoing, and we hope to obtain results by summer 2024. ImplicationsIt is vital for us to understand and measure error in the Demographic Index because this is necessary for measuring error in any statistics derived from the Index. And it is crucial that population statistics made by any future system should have measures of error. Assuming that our work shows promise, we will continue by measuring other types of error, and by creating use cases to test how these measures can be fed forward into secondary analyses (e.g. population estimation).

Women's Health Hubs: a rapid mixed-methods evaluation.

Women's sexual and reproductive health needs are complex and vary across the life course. They are met by a range of providers, professionals and venues. Provision is not well integrated, with inequalities in access. In some areas of the United Kingdom Women's Health Hubs have been established to improve provision, experience and outcomes for women, and to address inequalities and reduce costs. These models were established prior to the national implementation of Women's Health Hubs announced in the English 2022 Women's Health Strategy. To explore the 'current state of the art', mapping the United Kingdom landscape, and studying experiences of delivering and using Women's Health Hubs across England, defining key features and early markers of success to inform policy and practice. A mixed-methods evaluation, comprising three work packages: Mapping the Women's Health Hub landscape and context and developing a definition of Women's Health Hubs, informed by an online national survey of Women's Health Hub leaders, and interviews with regional stakeholders. In-depth evaluation in four hub sites, including interviews with staff and women, focus groups in local communities and documentary analysis. Interviews with national stakeholders and consolidation of findings from work packages 1 and 2. Fieldwork was undertaken from May 2022 to March 2023. The evaluation was initiated prior to the national scale-up of Women's Health Hubs announced in the 2022 Women's Health Strategy. Most areas of the United Kingdom did not have a Women's Health Hub. Seventeen active services were identified, established between 2001 and 2022. Women's Health Hubs were diverse, predominantly GP-led, with different perspectives of the role and definition of a hub. Women using hubs reported positive experiences, finding services caring and convenient. Implementation facilitators included committed, collaborative leaders working across boundaries, sufficient workforce capacity and a supportive policy context. Challenges included access to funding, commissioning, workforce issues, facilities and equipment, stakeholder engagement and wider system integration, priorities and pressures. Leaders were committed to addressing inequalities, but evidence of impact was still emerging. It was challenging to locate models; therefore, some may have been missed. Data availability limited assessment of impact, including inequalities. Some population groups were not represented in the data, and the evaluation was more provider-oriented. It was not possible to develop a typology of Women's Health Hubs as planned due to heterogeneity in models. Existing Women's Health Hub models were providing integrated approaches to meet local needs. Many were at an early stage of development. Evidence of system-level impact and costs was still emerging. Women's Health Hubs may widen inequalities if models are more accessible to advantaged groups. The important role of committed leaders in existing 'bottom-up' models may limit scalability and sustainability. Findings suggest that national scale-up will take time and requires funding and that it is necessary to design models according to local needs and resources. In 2023, the Department of Health and Social Care announced funding to establish a Women's Health Hub in every Integrated Care System in England. Future evaluation should consider system-level impact and costs, explore unintended consequences and test assumptions. This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135589) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 30. See the NIHR Funding and Awards website for further award information.

Resistance, regulation, and governmentality: interrogating the defunding of homeopathy in France and England (2000 to 2022)

AbstractThis paper employs a governmentality framework to explore resistance by CAM sceptics to homeopathy’s partial settlement in the public health systems of England and France, resulting in its defunding in both countries in 2018 and 2021, respectively. While partly dependent upon long-standing problematisations (namely, that homeopathy’s ability to heal is unproven, its mechanisms implausible, and its consequences for patients potentially dangerous), the defunding of homeopathy was also driven by the conduct of CAM sceptics, who undermined homeopathy’s position in strikingly different ways in both contexts. This difference, we suggest, is a consequence of the diverging regulatory arrangements surrounding homeopathy (and CAMs more generally) in England and France—and the ambivalent effects of CAM’s regulation. If law and regulation have been a key component of CAM’s integration and (partial) acceptance over the past four decades, the fortunes of homeopathy in England and France highlight their unpredictability as techniques of governmentality: just as the formal regulatory systems in England and France have helped to normalise homeopathy in different ways, they have also incited and galvanised opposition, providing specific anchor-points for resistance by CAM sceptics.

Integrated care systems in England: the significance of collaborative community assets in promoting and sustaining health and wellbeing.

Until recently the healthcare system in England was based on a commissioning/provider model. However, this has been replaced with an Integrated Care Systems (ICSs) approach, aimed at improving health and wellbeing and reducing inequalities through local collaborative partnerships with public sector organizations, community groups, social enterprise organizations and other local agencies. Part of this new approach is an emphasis on the role of community assets (i.e., local resources), that are considered integral to promoting positive health and wellbeing outcomes. This paper presents research from a series of three research studies on "community assets" conducted in the East of England within a newly established ICS. Based on analysis of qualitative data highlighting the lived experience of community asset members, this paper shows the positive wellbeing impact on vulnerable community members that assets provide. Further insight on the local impact and the collaborative nature of the research is provided suggesting that new asset-based approaches recognize the social determinants of health. This presents a shift away from positivistic linear approaches to population health and wellbeing to a new non-linear collaborative approach to addressing health inequalities and promoting wellbeing. The authors suggest that exploring this through a complexity theory lens could illuminate this further. Finally, the authors warn that while community assets have an important role to play in empowering citizens and providing much needed support to vulnerable and disadvantaged communities, they are not a substitute for functioning funded public sector services that are currently being undermined by ongoing local governments funding cuts. As such, while community assets can help ameliorate some of the negative effects people experience due to economic, structural and health disadvantages, only a more fair and more equal distribution of resources can address growing health inequalities.

Barriers and leverage points for seeing alcohol differently in integrated care systems in England: a senior stakeholder interview study

IntroductionIntegrated care systems (ICSs) are the latest major innovation aiming to develop localised, integrated health and social care services to improve population health in England. Nationally, alcohol has received limited...

Leadership in children and young people's nursing: an evolving journey.

Children and young people's (CYP) nursing leaders have experienced considerable challenges in the context of a complex health and social care system with rapidly changing organisational structures, including the establishment of integrated care systems in England on 1 July 2022. The CYP nursing lead at NHS England commissioned a review of CYP organisational structures in emerging integrated care systems across England. The review encompassed a vision for CYP services, leadership, governance structures and opportunities for progression. A proforma was used to collate data from CYP trusts, CYP standalone hospitals and children's wards in district general hospitals. Qualitative interviews were also undertaken with senior children's nurses. At the same time, the first author of this article interviewed senior children's nurses as part of a Florence Nightingale Foundation leadership scholarship. The aim was to explore how they navigated their leadership journey and understand what advice they may give to future leaders in CYP nursing. The findings in this article identify 'what good looks like' in terms of CYP nursing leadership. Six recommendations for future development and enhancement of CYP nursing leadership are outlined.

The cost of keeping patients waiting: retrospective treatment-control study of additional healthcare utilisation for UK patients awaiting elective treatment.

Long waiting times for elective hospital treatments are common in many countries. This study seeks to address a deficit in the literature concerning the effect of long waits on the wider consumption of healthcare resources. We carried out a retrospective treatment-control study in a healthcare system in South West England from 15 June 2021 to 15 December 2021. We compared weekly contacts with health services of patients waiting over 18 weeks for treatment ('Treatments') and people not on a waiting list ('Controls'). Controls were matched to Treatments based on age, sex, deprivation and multimorbidity. Treatments were stratified by the clinical specialty of the awaited hospital treatment, with healthcare usage assessed over various healthcare settings. Wilcoxon signed-rank tests assessed whether there was an increase in healthcare utilisation and bootstrap resampling was used to estimate the magnitude of any differences. A total of 44,616 patients were waiting over 18 weeks (the constitutional target in England) for treatment during the study period. There was an increase (p < 0.0004) in healthcare utilisation for all specialties. Patients in the Cardiothoracic Surgery specialty had the largest increase, with 17.9 [interquartile-range: 4.3, 33.8] additional contacts with secondary care and 17.3 [-1.1, 34.1] additional prescriptions per year. People waiting for treatment consume higher levels of healthcare than comparable individuals not on a waiting list. These findings are relevant for clinicians and managers in better understanding patient need and reducing harm. Results also highlight the possible 'false economy' in failing to promptly resolve long elective waits.

An Adaptive Research Approach to COVID-19 Forecasting for Regional Health Systems in England

A team of researchers worked with public health officials and clinical decision makers to create real-time models to help predict COVID-19 cases and hospital bed needs in the East of England. These models used up-to-date data and allowed officials to explore different scenarios and make informed plans. The models have also been applied in other countries and can be a valuable tool in future epidemics.

Trends in hospital admissions and prescribing due to diseases of the digestive system in England and Wales between 1999 and 2019: An ecological study.

This study aimed to investigate the trends in diseases of the digestive system hospital admissions (DDSHA) in England and Wales between (1999-2019). Secondary objectives were to investigate the type of admission and medication prescribing related to the digestive system in England. This is an ecological study using data from the Hospital Episode Statistics (HES) database and the Patient Episode Database between April 1999 and March 2019. The rate of hospital admissions with 95% confidence intervals (CIs) was calculated by dividing the number of DDSHA by the mid-year population. The trend in hospital admissions was assessed using a Poisson model. Overall, the rate of DDSHA rose by 84.2% (from 2231.27 [95% CI 2227.26-2235.28] in 1999 to 4109.33 [95% CI 4104.29-4114.38] in 2019 per 100,000 persons, trend test, P < .001). The most remarkable rise in hospital admission was seen in liver diseases, followed by other diseases of intestines with 1.85-fold, and 1.59-fold, respectively. Between 2004 and 2019, the overall prescribing rate for medications related to the gastrointestinal system increased by 74.6%, and stoma care related medications prescribing rate increased by 2.25-fold, followed by drugs affecting intestinal secretions and antisecretory drugs and mucosal protectants. There was an increase in hospital admission rate due to GI diseases in the United Kingdom (UK) by 84.2% from 1999 to 2019. The most remarkable rise in the rate of hospital admissions was seen in diseases of the liver and intestine.

Features of the formation of the progressive prison system in England

The article examines the peculiarities of the development of a progressive prison system in England. It is noted that the prerequisites for the implementation of this system were: an increase in the number of convicts, and therefore, prisoners; lack of prisons; decentralization and inefficiency of the prison system at that time; demoralizing consequences of execution of punishments. In 1838, the main regulations for reforming the penitentiary system of England were submitted to the government. The result of the proposed reform was the formation of a progressive prison system. The beginnings of the English progressive system of execution of punishments can be found in the activities of Captain D. McConochie, who in 1840 first applied its regulations to convict labourers on Norfolk Island near Australia, where the most dangerous criminals were sent. In England itself, this system was first introduced in 1842 in Pentonville Prison. The English progressive penitentiary system provided for several stages of imprisonment: solitary confinement, which took place in special solitary cells; collective imprisonment with joint labor during the day and separation at night; parole. The system had the following characteristic features: gradualness in the severity of the punishment, which depended on the arrestee himself; individualization of execution of sentences, based on a personal daily analysis of prisoners’ attitude to the regime and work; involvement of prisoners in the provision of prison activities; comprehensibility and accessibility for each detainee; significant educational influence on prisoners, most of whom were interested in softening prison conditions; parole as the highest reward for good behavior and conscientious work. The system had significant successes and attracted the attention of specialists and the public by reducing recidivism and a diverse set of educational measures. It also found its embodiment in the modern penitentiary system of England, in which the execution of prison sentences is organized according to a progressive system, which provides for solitary confinement with subsequent transfer to a general cell, where the regime of detention has three degrees. One of the main elements of organising and executing punishments related to deprivation of liberty is the classification and division of prisoners into four categories. According to these categories, there are four regimes of detention of prisoners.